Frequently asked questions about the FDA’s ban on menthol cigarettes
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Frequently asked questions about the FDA’s ban on menthol cigarettes

Here are some of the common questions about banning menthol cigarettes, the supposed evidence in support of a menthol cigarette ban, and a ban's possible consequences on public health and minority communities.

If the Food and Drug Administration (FDA) is successful in its bid to ban menthol cigarettes, it will likely have many negative consequences for public health and the criminal justice system. Menthol cigarettes account for a little more than one-third of all cigarette sales. The FDA hopes banning these products would significantly reduce smoking rates and narrow health disparities. But pursuing a policy of prohibition rather than a harm reduction strategy carries many risks, as demonstrated by the previously failed prohibitions of alcohol, marijuana, and gambling.

Here are some of the common questions about banning menthol cigarettes, the supposed evidence in support of a menthol cigarette ban, and a ban’s possible consequences on public health and minority communities.

Who smokes menthol cigarettes?

According to the FDA, there are nearly 18.6 million American menthol smokers. The FDA says nearly 85 percent of all black smokers use menthol-flavored products, compared to around 30 percent of white smokers who use menthol cigarettes. 

Are menthol cigarettes more dangerous than non-menthols?

Menthol and non-menthol cigarettes are both addictive and can cause smoking-related diseases, but non-menthol cigarettes are not safer than their menthol counterparts. Research published in the Journal of the National Cancer Institute found menthol smokers were somewhat less likely to develop lung cancer than non-menthol smokers. The report found:

“Black men are known to have a higher incidence of lung cancer and are more likely to smoke mentholated cigarettes compared with white men,” said Vanderbilt-Ingram Cancer Center’s William Blot, Ph.D. “It has been hypothesized that menthol in cigarettes influences smoking behavior, perhaps increasing dependency or adversely affecting the biology of the lung. However, our large study found no evidence to support those theories.”

…Among people smoking 20 or more cigarettes a day, menthol smokers were approximately 12 times more likely to develop lung cancer than never-smokers, while non-menthol smokers were about 21 times more likely to have the disease. The differences were mirrored for lung cancer death rates and were found to be statistically significant.

The researchers also found that both white and black menthol smokers reported smoking fewer cigarettes per day than non-menthol smokers. When it comes to the likelihood of quitting smoking, there was no significant difference between menthol and non-menthol smokers.

The authors said the findings suggest mentholated cigarettes are no more, and perhaps less, harmful than non-mentholated cigarettes.

The difference in lung cancer development may be because menthol smokers tend to smoke fewer cigarettes per day and start smoking later in life. If menthols are prohibited, those cigarettes left on the market may be considered safer by consumers, with a possible increase in the number of cigarettes smoked by those menthol smokers who switch to non-menthols. 

Are menthol cigarettes more addictive than non-menthols?

On standard dependency measures, such as the number of cigarettes smoked per day and the time to the first cigarette, menthol smokers are not more dependent than non-menthol smokers. There is also no significant difference in the quit rates between menthol and non-menthol smokers. The most recent evidence published in the Journal of the National Cancer Institute shows that quit rates among menthol and non-menthol smokers are indistinguishable. The study found no significant difference in quit rates between black and white smokers.

Are menthol cigarettes more popular among kids than non-menthols?

Fortunately, youth smoking rates in the United States are at a record low of 1.5 percent, according to the Centers for Disease Control and Prevention. Of that small percentage, more than 60 percent of middle school and high school students who are defined as current smokers use non-menthol cigarettes. Just 0.6 percent of middle and high school students used a menthol cigarette in the past 30 days.

States with the highest menthol consumption rates also have the lowest youth smoking rates. It is true that of the small group of African American middle and high school students who do smoke, most smoke menthol products. However, it should also be noted that black youth have lower smoking rates than other groups of young people, including non-Hispanic whites and Hispanics. 

Have menthol bans been implemented elsewhere? Were they successful?

Supporters of menthol prohibition have been disappointed by lackluster results in other jurisdictions that have banned the products, including Canada, the European Union, and Massachusetts. The most common result of menthol prohibition has been for the majority of menthol smokers to switch to equally dangerous non-menthol cigarettes, continue to buy illicit menthol, or use devices to flavor non-menthol cigarettes. As I noted in a recent piece:

The most optimistic case study for the prohibition of menthols comes from Canada. According to a study of Canada’s menthol ban, while the vast majority continued to smoke after the ban was implemented, a significant portion reported quitting. The study found “59.1 percent of pre-ban menthol smokers switched to non-menthol cigarettes; 21.5 percent quit smoking and 19.5 percent still smoked menthols, primarily purchased from First Nations reserves.” These results might seem somewhat underwhelming but are still impactful. But when we compare the menthol smokers to non-menthol smokers, we see a lackluster result. 

According to the authors of the study, menthol smokers increased their attempts to quit smoking, relative to non-menthol smokers by 9.7 percent. However, overall, just 7.5 percent more menthol smokers quit compared to non-menthol…

The European Union, with its 27 member states and a population of about 450 million, is the largest region to have banned menthol cigarettes. Menthols were already unpopular in Europe. Poland had the largest menthol market in the European Union at 28 percent, closest to America’s market at 36 percent. A preprint study funded by the Norwegian Cancer Society in partnership with the Polish Health Ministry found no statistically significant change in cigarette sales after the ban.

How would the prohibition of menthols likely be enforced?

The FDA says menthol prohibition would be enforced only against “manufacturers, distributors, wholesalers, importers, and retailers.” However, any implication that a ban would only affect big tobacco companies and established retail stores is misconceived. There are already laws on the books that would impose severe penalties on individuals who sell menthols post-prohibition. Anyone selling, importing, or distributing menthol cigarettes would be committing a crime and could land themselves in prison. Thanks to the Federal Cigarette Contraband Trafficking Act (CCTA), smuggling menthol cigarettes across state lines could result in five years in prison. Every state also has laws on the books that criminalize the unlicensed sale and distribution of tobacco products.

Additionally, the possession of untaxed cigarettes is already illegal in 36 states and the District of Columbia. States and localities could enact other laws to clamp down on any increase in the illicit tobacco trade. 

Why are some civil liberties and criminal justice reform groups concerned the ban would negatively impact minority communities?

Aamra Ahmad, senior legislative counsel with the American Civil Liberties Union, said a ban on menthol cigarettes would disproportionately impact minority communities:

“Time and time again, we see encounters with police over minor offenses — for Daunte Wright it was expired tags, for George Floyd it was using a counterfeit bill, for Eric Garner it was selling loose cigarettes — result in a killing. There are serious concerns that the ban implemented by the Biden administration will eventually foster an underground market that is sure to trigger criminal penalties which will disproportionately impact people of color and prioritize criminalization over public health and harm reduction.”

A ban on menthol cigarettes should be expected to hurt communities of color, spur the growth of black markets for methol products, lead to more policing and incarceration, and undermine a variety of criminal justice reforms that cities and states have made in recent years.

Rather than prohibition, what is an alternative harm reduction strategy?

While smoking rates have gradually declined over the last few decades, 12.5 percent of American adults continue to smoke despite the widely known dangers and many smoking cessation resources available. One reason why so many Americans keep smoking traditional cigarettes is that public health officials have mostly failed to let them know that nicotine alternatives like e-cigarettes are substantially safer than combustible cigarettes. 

According to the Health Information National Trends Survey, just 2.6 percent of adults correctly believe e-cigarettes are much less harmful than traditional cigarettes. Since there is no burning tobacco in e-cigarette products, they are substantially safer than traditional cigarettes. Research also shows e-cigarettes are far more effective than nicotine replacement therapies at helping smokers quit.

Rather than resorting to the failed prohibitionist policies of the past, the FDA and Biden administration should apply the harm reduction model to tobacco policy. The federal government could focus on educating the public about safer nicotine delivery products, and the latest smoking cessation products available as part of a pragmatic approach to improving public health as people choose better options than conventional cigarettes. The harm reduction model has been successfully used by governments to reduce sexually transmitted diseases, reduce overdose deaths and treat drug addiction. In the case of smoking and menthols, a harm reduction strategy would be far more effective in reducing smoking than banning menthols.